Stimulus prompts talk of health care rationing

HEALTH CARE

A relatively small provision in the stimulus bill that would devote about $1 billion in government research funds to figure out which drugs and medical devices work better than others has some industry groups, conservative talk-show hosts and others crying the "r" word: rationing.

A portion of the House bill reportedly retained in the Senate's proposed $789 billion compromise version calls for the creation of a federal agency that would help coordinate research on "comparative effectiveness," a wonky term that means determining which treatments work better than others.

To proponents, such research would improve quality of care and reduce health costs by limiting the use of drugs and treatments that do not work well. They contend the $2 trillion the country spends on health care would be better spent if government knew how well various drugs and treatments worked.

Opponents' fears

But opponents argue the government could use the information to deny certain treatments or ration health care options for patients.

"The intent is to use that information to ration care. Why else would you come up with the research to help people choose what provides a lot of value for the money and what doesn't?" said Michael Cannon, director of health policy studies at the Cato Institute, a libertarian think tank.

Supporters of comparative effectiveness research contend the naysayers are simply using politically charged language such as rationing - as well as references to socialized health care - to support industry interests and derail greater health reform efforts.

"It's a very clever effort by a bunch of well-paid lobbyists funded by people who don't want the American people to know some pills work better than others," said Bill Vaughan, health policy analyst for Consumers Union, the nonprofit organization that publishes Consumer Reports.

AARP's chief executive officer, Bill Novelli, accused critics of the comparative effectiveness provision of using "scare tactics" to block health reform. "They fear it will cut the profits they make on ineffective drugs and equipment," Novelli said in a statement on behalf of the organization, which primarily represents seniors. "But they won't tell you this research could save your life by giving your doctors better information so they can prescribe the best treatments available to you."

Drug and device manufacturers don't officially oppose comparative effectiveness, but they do want a say in determining the details of how the research money can be used. The research funds would go to the National Institutes on Health and other government groups, according to the bill.

The unspoken word

A coalition called the Partnership to Improve Patient Care, which includes medical device manufacturers and pharmaceutical companies along with patient and provider groups, says it supports comparative effectiveness research - as long as the information is not used to make decisions about cost.

David Mi Martino, spokesman for the group, wouldn't even utter the "r" word. "We just don't think the government should be in the business of determining what people can and can't have for health care options," he said.

The coalition helped drive the inclusion of the word "clinical" in the Senate version of the bill, which means outcomes rather than price would be the determining factor of the research. Details about whether the final version contained the language could not be confirmed Wednesday.

Health insurers stand to gain financially from comparative effectiveness studies if research shows some cheaper treatments work as well or better than more expensive options.

Benefit to insurers

America's Health Insurance Plans, the trade group that represents insurers, released a statement Wednesday in support of comparative effectiveness funding.

"With comparative effectiveness, patients and providers will be able to assess drugs, technologies, and treatment options and make decisions that best reflect the patients' needs and preferences," said Karen Ignagni, the group's president and chief executive officer. "We applaud efforts to address this important priority in the current economic recovery bills."

The Cato Institute's Cannon, in a departure from other groups critical of government involvement in such research, actually supports the concept of rationing health care. He just doesn't want government to do it.

"It is perfectly legitimate for Congress to ration care in government programs," said Cannon, who believes any government effort to conduct comparative effectiveness studies will be quashed by industry. "That's exactly why you don't want government paying for medical care."